A decade ago, hospitals began to recognize that cigarette smoking by staff and patients contradicted their mission of promoting health. Programs were created to educate, encourage, and incentivize people to stop smoking. These programs helped some individuals—but the broader problem remained. Real change only occurred when hospital boards and policymakers decided that smoking would no longer be permitted. When policy changed, behavior followed, and the culture shifted.

Policy is where long-term, systemic change happens. It transforms regulations, laws, and even social norms—though the process often takes time. Effective policy work includes five components: research, outreach, education, advocacy, and policy change. Policy changes systems.

Programs, by contrast, are often more visible and appealing because they produce faster, more tangible results. But their impact is typically short-term and limited to the individual level. Programs can also drain available resources and attention, sometimes distracting from deeper structural solutions. Consider the difference between distributing food boxes versus advocating to increase SNAP benefits or raising the minimum wage. The first alleviates immediate need; the second addresses the conditions that created hunger in the first place.

A useful metaphor: If you find a few dead fish in your lake, you might study the fish. If half the fish are dead, you study the lake. If fish in five neighboring lakes are dying, you examine the groundwater. Policy and systems change are about fixing the groundwater.

Strategic Policy and Advocacy Projects

Strategic Policy and Advocacy Projects aim to align people, data, and strategy to drive systemic change. These projects:

• Generate data (quantitative and qualitative) to surface and test assumptions.

• Inform new laws, regulations, and policies.

• Identify leverage points and track shifts within systems over time.

• Engage people with lived experience in shaping and advancing policy.

• Focus on effective implementation of new or revised policies.

Examples of Policy in Action

1. PEEPS: Pima Early Education Program Scholarships (Arizona) A decade-long effort to increase access to quality early education led to a $10 million Pima County investment, alongside contributions from local governments. Nearly 2,000 parents annually—earning under 300% of the poverty level—can now enroll their three- to five-year-olds in quality preschool. The program not only expanded access but also strengthened the childcare sector, improved working conditions for educators, and elevated cultural responsiveness in early education. None of this came from a single “program” alone—it resulted from persistent policy advocacy and coalition-building.

2. Santa Ana, California: Environmental Justice through Policy Change 

Yvette Cabrera, a senior reporter at the Center for Public Integrity, an investigative news nonprofit, where she covers inequality in economic and social well-being with a focus on environmental justice issues gives us another example of the need to emphasize policy over program.  She describes it this way:

I began reporting on soil lead contamination in Santa Ana in 2015 after I had an epiphany while reporting a story about California probation agencies that were turning minors in juvenile detention over to immigration authorities. As I interviewed mothers across Southern California, documenting the history of how their sons ended up in juvenile hall, I noticed these mothers had similar stories — their sons had trouble learning in school, couldn’t sit still or focus, and had been diagnosed with attention deficit hyperactivity disorder.  At the same time, I serendipitously came across a magazine article featuring a hypothesis about the link between lead and crime — how the rise and fall of leaded gasoline in cars may have contributed to the rise and fall of violent crime in America — and, intriguingly for my work, a link between lead exposure and ADHD.

I came to the realization that I was only covering half the story. I was writing about the environment of these young boys in terms of the violence, poverty, and high police presence in their neighborhoods, but I wasn’t considering how their physical environment — neighborhoods next to freeways, surrounded by polluting industries — might be contributing to their behavioral issues. Many of the minors in Orange County’s juvenile hall are from neighborhoods in Santa Ana where young Latinos face many of these issues.

 I wondered, “Is there a way to address this issue by digging deeper for a root cause?” I discovered that the number of children in Santa Ana with elevated blood lead levels was much higher than in any other city in the county. I wanted to know why.  In 2015, I tested the soil to see if the ground on which the city’s children were playing was a potential source of lead exposure… …This was much more than just a story about soil contamination. As I listened to the stories of the residents, I saw how families in barrios like Logan cared deeply about providing their children with a healthy place to live. At a time when Americans are more acutely aware of the impacts of structural and systemic inequities, I saw the importance of showing how historic patterns of permitting, land-use decisions, zoning, and regulatory policies continue to determine who in America gets to breathe healthy air and live in a safe environment.

Cabrera’s investigation into root causes created these changes to the system. Her investigation exposed systemic inequities in zoning, permitting, and land use that perpetuated environmental hazards in low-income Latino neighborhoods. Her work catalyzed major policy shifts:

• A community-led coalition, ¡Plo-NO! Santa Ana!, conducted independent soil testing confirming widespread contamination.

• The city council approved a comprehensive general plan update to address lead hazards (2022).

• UC Irvine received a $2.7 million federal grant to study lead exposure impacts on children’s health and learning.

• In 2024, Santa Ana imposed a moratorium on new industrial development near affected neighborhoods to investigate long-term health impacts.

This was not a “program.” It was systemic reform—policy-level change rooted in community advocacy and data.

3. Arizona Grandparents Ambassadors: Policy for Kinship Families When grandparents raising grandchildren realized they received fewer supports than licensed foster parents, they organized. With support from the Southwest Center for Economic Integrity, they trained, advocated, and pushed for legislative action. Twelve years later, their persistence led to:

• Monthly stipends for kinship caregivers,

• Expansion of the Kinship Family Fund,

• Automatic eligibility for TANF child-only benefits,

• Official recognition of September as Kinship Family Month

• Streamlined licensing and training processes.

As Kelly Griffith, CEI’s Executive Director, put it: “Policy work takes time, and in the end, it is still about relationships.”

What It Takes to Make Policy Work

• Cultivate relationships with decision-makers, nonprofits, business and faith groups, and those most affected.

• Build coalitions and align interests across sectors.

• Support advocates through training and strategic coordination.

• Stay adaptable to shifting political and economic contexts.

• Keep focus on the root causes, even amid complexity and setbacks.

Policy work is not quick, easy, or glamorous. It requires patience, long-term vision, and the ability to navigate complexity. But when successful, policy creates the conditions where programs can thrive sustainably—and where people no longer need programs at all.

A food box feeds a family for a day; a fair wage feeds generations. A preschool scholarship opens one classroom; public investment opens a pathway for thousands. When we choose policy over program, we choose solutions that endure—solutions that shift the “groundwater” of our communities.  Real change happens not when we add another program to the mix, but when we reshape the system so that the problem no longer exists. Policy is the most powerful program of all.